Revolutionising musculoskeletal self-management support through co-design

getUBetter is a digital self-management support platform for all common MSK conditions and at the heart of our success to date has been co-design.

We have become well known for our commitment to collaborative co-design, ensuring our platform meets the needs of patients, clinicians, integrated care systems and health boards.

In this article we will share the co-design journey we have been on and how those learnings have helped us and our customers to deliver digital MSK self-management support at scale.

We have been working in an innovative co-production partnership with the South West London ICS for over 4 years. The ICS commissioned getUBetter to help them provide digital self management support across all their common MSK pathways to improve the delivery of MSK care to their local population. Their challenges reflected those of the wider NHS and there was a shared belief that nobody should have to wait for self-management support for their MSK condition and that support should be available at the earliest opportunity and available 24 hours a day and 365 days per year.

Our approach

Our approach has been routed in the evidence base for MSK self-management support and co-design.  We continuously run focus groups and design workshops with all key stakeholders to ensure our usability, implementation and evaluation approach is user led.

Co-design with patients

Patient-centricity is the cornerstone of our co-design approach. Engaging patients in the co-design process is fundamental to its success.

To ensure as many people as possible canaccess and benefit from getUBetter we work with a range of people of different ages, accessibility needs, and cultures.  Through an iterative design process this means our content is accessible, intuitive, inclusive and easy to follow and we deeply understood barriers to adoption.

Co-design with clinicians

We engaged with all the key clinical stakeholders involved across all common MSK pathways.  This included GPs, Physiotherapists, Emergency clinicians, Orthopaedic Consultants and Occupational Health Specialists amongst others.  Their expertise was fundamental in ensuring getUBetter follows best practice and is clinically safe but also how digital self-management support can be seamlessly integrated into routine care.

Co-design with clinical transformation experts

The integration and adoption of digital self-management support into a health system necessitates more than just creating a user-friendly app. Collaborating with clinical transformation experts ensured we understood the best approach to deploy and then drive adoption.  Important lessons were learnt about minimising digital exclusion.

Co-designing with Academic Partners

Academic partners bring cutting-edge research and innovation to the table. Their involvement in co-design ensured what we were doing was rooted in the latest evidence.

Additionally, academic partnerships have enabled the rigorous evaluation of getUBetter’s effectiveness, generating essential data and insights to guide its ongoing development.

What we have learnt

Below are the key learnings from our co-design approach

• Ongoing real world evidence of the benefits of digital-self management support must be delivered
• Providing self-management support for all common MSK conditions is important from a health system perspective to provide a coordinated and standardised approach that is manageable at system level
• Self-management support should be provided at the earliest opportunity and be made available across the whole pathway
• Self-management support needs to be localised to meet the needs of the local pathways and available services down to place level
• Digital exclusion is an important problem to mitigate as much as possible
• Clinical safety and managing clinical risk is paramount
• Integration with primary care EPRs and NHS Login is important
• Adoption is as much about the approach to people and process as it is to the technology

What we have implemented

• We have developed an approach to continuously measuring benefits with health systems
• We now provide self-management support for the conditions back, back and leg, neck etc and continue to develop
• getUbetter is deployed across the whole pathway including primary care, community services, secondary care, emergency care, pharmacies and other non-traditional parts of the pathway including libraries and leisure centres and is available by self-referral
• We localise each condition to the local pathway and the local services that are available including 3^rd sector services
• We have implemented the following capability in the getUBetter platform.
  • Cross mobile and web access
  • Touch to speak in multiple languages
  • Zoom
• We are registered medical device, DTAC certified and comply with DCB-0129. We provide safety netting at scale and all pathways are tested and signed off before deployment
• We have EMIS integration and working toward TPP and NHS Login
• We have developed a repeatable rapid deployment and clinical transformation methodology that delivers health system wide deployment

Conclusion

Co-design has been central to the progress that we have made and we were awarded the HealthTech Partnership of the Year at the HSJ Partnership Awards 2023.

Other achievements include

• 18 ICS contracts
• NHS England Digital MSK Playbook
• ORCHA App library highest scoring MSK App
• Nice Early Value Assessment approval for use in the NHS for non-specific lower back pain

We continue to hold regular co-design events and iterate based on feedback and apply the same methodology for all our new modules.

• Perioperative support
• Pain support
• Women’s Pelvic Health support